Study of Rimonabant - Treatment of Cannabis Dependence

[Dragonfan]

APSAD

 

A Pilot Study of Rimonabant for the Treatment of Cannabis Dependence

 

Dr Mark Montebello, Ms Carolyn Mutch, Ms Rowan Mason, A/Prof James Bell, The Langton Centre, Surry Hills, Australia

 

Objective: To assess acceptability and tolerability of rimonabant for treatment of cannabis dependent young people with psychiatric co-morbidity.

 

Background: Rimonabant, a cannabinoid antagonist, has not been trialled in treatment of cannabis dependence.

 

Method: Open label pilot study. Cannabis dependent patients seeking either to cease cannabis use, or to avoid relapse, were recruited from one psychiatric and three drug treatment centres. Participants were offered 20mg of rimonabant daily, for up to three months. Participants were interviewed at baseline, one month, three months and six months. Primary end-points were retention in treatment, cannabis use and drug tolerability. Secondary outcomes were use of other drugs including tobacco, weight and psychiatric co-morbidity.

 

Results: Twelve patients participated in the trial. 92% had significant psychiatric histories. Participants took rimonabant for a mean of 25.1 days. Side-effects of rimonabant were reported by 64%, the most common being nausea/vomiting (36%) and anxiety (36%). Side–effects were reported as the reason for discontinuing in eight participants. Self-reported cannabis use in the past 28 days dropped significantly at all follow-up time points: from 27.1 to 4.0 for those attending at one month, from 26.0 to 1.5 at three months and from 26.6 to 1.8 at six months. No change in BMI or other drug use observed. Qualitative data revealed most patients felt that rimonabant helped them to abstain from smoking cannabis and that subjective effects of cannabis were minimal when taking rimonabant.

 

Conclusions: This pilot study demonstrated significant medication side-effects and poor retention. However, the drug did appear to be useful in several participants, interrupting cannabis dependence, and sustained reductions in cannabis use following treatment suggest that rimonabant may have a place as a short-term intervention in this population.

 

This was presented here in Australia in November at the Australian Professional Society on Alcohol and Other Drugs conference . . . but, reports from 2007 state/d . . . Shortly after market introduction, press reports and independent studies suggest that side effects occur stronger and more commonly than shown by the manufacturer in their clinical studies. Reports of severe depression are frequent. This is deemed to result from the drug being active in the central nervous system, an area of human physiology so complex that the effects of a drug are extremely difficult to predict or anticipate.

 

Because the drug has the opposite effects of cannabinoid receptor agonists such as tetrahydrocannabinol (THC, one of the substances found in marijuana), which is neuroprotective against excitotoxicity, it can be theorized that Rimonabant promotes the development of neurodegenerative diseases of the central nervous system such as Multiple sclerosis, Alzheimer's disease, Amyotrophic lateral sclerosis (ALS), Parkinson's disease, and Huntington's disease in persons who are susceptible. The reported development of previously clinically silent multiple sclerosis in one patient taking Rimonabant suggests that any patients with an underlying neurological condition should not take Rimonabant, given the neuroprotective role of the endocannabinoid system in many experimental paradigms of neurological disease. On 15 June 2007, BBC News reported that a committee advising the US FDA had voted not to recommend the drug's approval because of concerns over suicidality, depression and other related side effects associated with use of the drug . . . and . . . on 23rd October 2008, the European Medicines Agency (EMEA) released a press release stating that its Committee for Medical Products for Human Use (CHMP) had concluded that the benefits of Acomplia [Rimonabant] no longer outweighed its risks and subsequently recommended that the product be suspended from the UK market. Sanofi-Aventis later released a press statement stating that the drug had been suspended.

 

But they are recommending its use here? ]

[freddie]

Side-effects of rimonabant were reported by 64%, the most common being nausea/vomiting (36%) and anxiety (36%).

Shortly after market introduction, press reports and independent studies suggest that side effects occur stronger and more commonly than shown by the manufacturer in their clinical studies. Reports of severe depression are frequent. This is deemed to result from the drug being active in the central nervous system, an area of human physiology so complex that the effects of a drug are extremely difficult to predict or anticipate.

I can't believe a drug like this would be used as and aid to giving up cannabis.

 

I have taken quite a few breaks from pot (one lasted 5 years) and I have always found giving up quite easy. The only symptom I have had is a couple of sleepless nights and then fine. Nicotine and alcohol have been a different story.

[Nooby]

"Side-effects of rimonabant were reported by 64%, the most common being nausea/vomiting (36%) and anxiety (36%). "

 

"Qualitative data revealed most patients felt that rimonabant helped them to abstain from smoking cannabis and that subjective effects of cannabis were minimal when taking rimonabant."

 

The subjective effects being anti-emetic and stress relief you mean?

 

Dumbarses.